The present invention relates to a surgical tool which is used in conjunction with a contact laser.
Direct contact lasers, such as neodymium:yttrium-aluminum-garnet (ND:YAG) contact lasers, have been found useful in sinus surgery, head and neck surgery (otolaryngology), oral surgery, tracheobronchial surgery, tonsillectomies, bronchoscopic, cystoscopic and gastroscopic surgery. Also the contact laser may be useful in conjunction with other types of endoscopic or microscopic surgical procedures. KTP or potassium titanyl phosphate lasers are ND:YAG lasers that use a crystal of KTP at their output. Direct contact lasers differ from radiation emitting lasers in that contact probes (the laser crystals attached to the end of the laser core) work only when in direct contact with the tissue or medium at the surgical site. Contact lasers use thermal energy rather than laser light to remove, cut or cauterize a surgical site. Direct contact laser surgery provides the surgeon with tactile feedback or stimulation during the surgical procedure. This enhances the surgical technique and reduces the learning curve associated therewith.
U.S. Pat. No. 4,146,019 to Bass discloses a glass fiber laser core encased in a sheath. An irrigation fluid line is attached to the laser core sheath and extends beyond the distal end of the laser core. A laser crystal is affixed to the distal end of the laser core and is covered by an end cap. The end cap defines a window which is washed by irrigation fluid supplied by the irrigation fluid line attached to the sheath of the laser core. The laser disclosed in the Bass patent disclosure is not a direct contact, thermal surgical laser tip. The Bass laser emits laser light which irradiates the surgical site. The encased laser core and the attached irrigation fluid line are loosely contained in the lumen of a significantly larger outer tube. In addition to the laser core, six other lines (fiber optic lines, irrigation and suction lines) are loosely contained in the lumen of the large outer tube. Even though the laser core can move laterally in the larger outer tube, Bass does not disclose the use of a direct contact laser because the attached irrigation fluid line protrudes beyond the distal end of the laser core and end cap. In contact laser surgery, the surface of the contact laser tip must be completely exposed such that the surgeon can place the tip on the surgical site.
U.S. Pat. No. 5,154,166 to Chikama discloses a disposable endoscope cover. U.S. Pat. No. 4,770,653 to Shturman discloses a device having a laser core which terminates at a distal end of a long, hollow rod. The laser core does not move beyond the distal end of the rod. Shturman also shows a radiation transparent end cap which is attached to the end of the laser core. Shturman further discloses a rigid positioning body containing the laser crystal which can move axially within a hollow conduit by a translational force applied to a guide wire attached to the body. However, the Shturman laser is not a direct contact, thermal laser. Shturman specifically discusses the emission of laser radiation from the laser crystal at the distal end of the optical fiber.
U.S. Pat. No. 4,419,987 to Ogiu discloses a laser endoscope having a disc shaped glass cover at the distal end of a laser core guide. Ogiu specifically relates to laser beams emitted from a laser source through the laser guide. Ogiu does not show, teach or suggest the use of a direct contact, thermal laser tip. U.S. Pat. No. 4,418,688 to Loeb discloses a microcatheter having a directable, light emitting laser. Cables running through a collar near the distal end of the conduit enable the upper or lower angular adjustment of a laser affixed to a laser power core. Loeb further discusses a lens which focuses the laser light at a specific location. Loeb does not show, teach or suggest the use of a direct contact, thermal surgical laser tip. U.S. Pat. No. 4,207,874 to Choy discloses a laser tunneling device which uses a laser to irradiate an item.
U.S. Pat. No. 4,850,351 to Herman discloses a wire guided laser catheter having longitudinal channels formed in the lumen of a conduit. The channels carry waveguides, such as optical fibers, and these optical fibers are adapted to transmit laser light. The optical fibers are not secured within the channels and are permitted to longitudinally move within the channel as the catheter conduit is bent. The distal ends of the optical fibers are secured at the distal portion of the catheter conduit. The fibers are secured to an optically transparent distal end cap which is formed from an optical glass which emits the radiant energy of the laser.
U.S. Pat. No. 4,313,431 to Frank discloses an endoscope apparatus with a laser light conductor. Frank provides that a tumor is irradiated with light emitted from a conventional laser passing through a light conductor. The light conductor is slidably guided by a spring loaded push wire extending through a pipe. The laser crystal at the end of the light conductor moves beyond the distal end of the pipe based upon the longitudinal movement of the push wire. The push wire is rearwardly biased thereby resisting forward axial movement of the laser crystal. However, Frank discloses the use of an irradiating laser tip and not a direct contact laser crystal tip.